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Wheeler DC., Townend JN., Landray MJ.

BACKGROUND: Patients with end-stage kidney failure have a greatly increased risk of developing premature cardiac and vascular disease. However, little is known about the evolution of cardiovascular diseases in individuals with less severely impaired kidney function. METHODS: The prevalence of cardiovascular diseases and of suspected cardiovascular risk factors was studied in a group of 369 individuals (median age, 63 years, 67% male) with various degrees of impaired kidney function (calculated creatinine clearances 6 to 105 mL/min), in 103 patients with angiographically proven coronary artery disease, and in 103 apparently healthy individuals. These patients are being followed prospectively. RESULTS: Of those patients with kidney disease, 34% had a history of vascular disease and 21% had left ventricular hypertrophy on electrocardiogram at baseline. Traditional risk factors were prevalent, with a history of hypertension in 76% of kidney disease patients, diabetes in 15%, and dyslipidemia with reduced low-density lipoprotein (LDL) cholesterol, elevated serum triglycerides, and decreased high-density lipoprotein (HDL) levels. Other possible cardiovascular risk factors include elevated concentrations of plasma homocysteine, as well as low serum albumin and hemoglobin levels. Patients with more severely impaired renal function had lower diastolic blood pressures, lower LDL and HDL cholesterol levels, were more anemic, and had higher plasma homocysteine concentrations. CONCLUSIONS: Vascular disease and left ventricular hypertrophy are prevalent among patients with chronic kidney disease not requiring dialysis. In addition to traditional risk factors, other features of the uremic syndrome such as anemia, hyperhomocysteinemia, and inflammation (suggested by hypoalbuminemia) may contribute.